Healthcare Provider Details

I. General information

NPI: 1902652514
Provider Name (Legal Business Name): JOHANNA ELIZABETH SWEET RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 PROSPECT AVE
WEST SPRINGFIELD MA
01089-4555
US

IV. Provider business mailing address

352 PROSPECT AVE
WEST SPRINGFIELD MA
01089-4555
US

V. Phone/Fax

Practice location:
  • Phone: 828-279-0838
  • Fax:
Mailing address:
  • Phone: 828-279-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number266607
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: